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Predicting Diagnosed Depression and Anti-depressant Treatment in Institutionalized Older Adults by Symptom Profiles: A Closer Look at Anhedonia and Dysphoria*

Published online by Cambridge University Press:  31 March 2010

Michael J. Stones ,
Leah D. Clyburn ,
Margaret C. Gibson  and
M. Gail Woodbury
Michael J. Stones*
Affiliation:
Lakehead University
Leah D. Clyburn
Affiliation:
Lakehead University
Margaret C. Gibson
Affiliation:
Parkwood Hospital, London, ON
M. Gail Woodbury
Affiliation:
Lawson Health Research Institute, London, ON
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être addressées à : Dr. Michael Stones, Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1. ([email protected])
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Abstract

The purpose of this study was to examine the relationships of diagnosis and treatment of depression with anhedonic and dysphoric symptom presentation, using the Minimum Data Set 2.0. Participants were from two sectors of long-term care: 70 nursing home residents and 92 residents in a Veterans' Care Service. The samples differed in their sex distribution and in cognition. A series of logistic regressions that controlled for demographics, type of facility, and cognition showed that dysphoric symptoms predicted diagnosed depression, whereas anhedonic symptoms predicted anti-depressant medication use without a concomitant diagnosis. The findings are consistent with a hypothesis that, in long-term care settings, anhedonic symptoms contribute less to a diagnosis of depression than do dysphoric symptoms. However, findings that anhedonic symptoms relate to treatment have implications for care-planning protocols.

Résumé

L'objectif de cette étude est d'analyser les liens qui existent entre le diagnostic et le traitement de la dépression dysphorique-anhédonique, au moyen du Minimum Data Set 2.0. Les participants provenaient de deux secteurs des soins de longue durée : 70 vivaient en maison de retraite et 92 dans un centre de soins pour anciens combattants. Les échantillons étaient différents pour ce qui est de la distribution sexuelle et la cognition. Une série de régressions logistiques mesurant les données démographiques, le type d'infrastructure et la cognition montrent que les symptômes dysphoriques permettent de prédire la dépression diagnostiquée, tandis que les symptômes anhédoniques permettent de prédire l'utilisation d'antidépresseurs sans diagnostic concomitant. Les résultats sont compatibles avec l'hypothèse que, dans des contextes de soins de longue durée, les symptômes anhédoniques contribuent dans une moindre mesure au diagnostic de la dépression que les symptômes dysphoriques. Cependant, les résultats qui indiquent que les symptômes anhédoniques sont liés au traitement ont une incidence sur les protocoles de programmation des soins.

Keywords

aginganhedoniadepressionelderlydysphoriavieillissementanhédoniedépressionpersonnes âgéesdysphorie
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 25 , Issue 2 , Summer/Été 2006 , pp. 153 - 159
Copyright
Copyright © Canadian Association on Gerontology 2006

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Footnotes

*

The authors would like to acknowledge a grant in support of this work from the Parkwood Hospital Foundation, London, Ontario.

References

Alexopoulos, G.S., Meyers, B.S., Young, R.C., Kakuma, T., Feder, M., Einhorn, A., et al. (1996). Recovery in geriatric depression. Archives of General Psychiatry, 53(4), 305–312.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
Anderson, R.L., Buckwalter, K.C., Buchanan, R.J., Maas, M.L., & Imhof, S.L. (2003). Validity and reliability of the Minimum Data Set Depression Rating Scale (MDS-DRS) for older adults in nursing homes. Age and Ageing, 32, 435–438.CrossRefGoogle Scholar
Bagley, H., Cordingley, L., Burns, A., Mozley, C.G., Sutcliffe, C., Challis, D., et al. (2000). Recognition of depression by staff in nursing and residential homes. Journal of Clinical Nursing, 9(3), 445–450.CrossRefGoogle ScholarPubMed
Blazer, D.G. (2003). Depression in late life: Review and commentary. Journal of Gerontology: Medical Sciences, 58A, 249–265.Google Scholar
Brown, M.N., Lapane, K.L., & Luisi, A.F. (2002). The management of depression in older nursing home residents. Journal of the American Geriatrics Society, 50, 69–76.CrossRefGoogle ScholarPubMed
Burrows, A.B., Morris, J.N., Simon, S.E., Hirdes, J.P., & Phillips, C. (1995). Development of a Minimum Data Set-based depression rating scale for use in nursing homes. Age and Ageing, 29, 165–172.CrossRefGoogle Scholar
Canadian Institute of Health Information. (1998). The quality of caring: Chronic care in Ontario (Provincial mini-status report). Ottawa: Author.Google Scholar
Datto, C.J., Oslin, D.W., Streim, J.E., Scheinthal, S.M., DiFilippo, S., & Katz, I.R. (2002). Pharmacologic treatment of depression in nursing home residents: A mental health services perspective. Journal of Geriatric Psychiatry and Neurology, 15(3), 141–146.CrossRefGoogle ScholarPubMed
Gallo, J.J., Anthony, J.C., & Muthén, B.O. (1994). Age differences in the symptoms of depression: A latenttrait analysis. Journal of Gerontology: Psychological Sciences, 49, P251–P264.CrossRefGoogle Scholar
Gallo, J.J., & Rabins, P.V. (1999). Depression without sadness: Alternative presentations of depression in late life. American Family Physician, 60, 820–826.Google ScholarPubMed
Gallo, J.J., Rabins, P.V., & Anthony, J.C. (1999). Sadness in older persons: A 13-year follow-up of a community sample in Baltimore, Maryland. Psychological Medicine, 29, 341–350.CrossRefGoogle Scholar
Geiselmann, B., & Bauer, M. (2000). Subthreshold depression in the elderly: Qualitative or quantitative distinction? Comprehensive Psychiatry, 41(Suppl. 1), 32–38.CrossRefGoogle ScholarPubMed
Gruber-Baldini, A., Zimmerman, S., Mortimore, E., & Magaziner, J. (2000). The validity of the Minimum Data Set in measuring the cognitive impairment of persons admitted to nursing homes. Journal of the American Geriatrics Society, 48, 1601–1606.CrossRefGoogle ScholarPubMed
Hawes, C., Morris, J.N., Phillips, C.D., Mor, V., Fries, B.E., & Nonemaker, S. (1995). Reliability estimates of the Minimum Data Set (MDS) for nursing home resident assessment and care screening. Gerontologist, 2, 172–178.CrossRefGoogle Scholar
Heston, L.L., Garrard, J., Makris, L., Kane, R.L., Cooper, S., Dunham, T., et al. , D. (1992). Inadequate treatment of depressed nursing home elderly. Journal of the American Geriatrics Society, 40, 1117–1122.CrossRefGoogle ScholarPubMed
Hirdes, J.P., Ikegami, N., Jónsson, P.V., Topinková, E., Maxwell, C., & Yamauchi, K. (2000). Cross-national comparisons of antidepressant use among older persons based on the Minimum Data Set (MDS). Canadian Journal on Aging, 19, 18–37.CrossRefGoogle Scholar
Jones, R.N., Marcantonio, E.R., & Rabinowitz, T. (2003). Prevalence and correlates of recognized depression in U.S. nursing homes. Journal of the American Geriatrics Society, 51, 1404–1409.CrossRefGoogle ScholarPubMed
Lasser, R.A., & Sunderland, T. (1998). Newer psychotropic medication use in nursing home residents. Journal of the American Geriatrics Society, 46(2), 202–207.CrossRefGoogle ScholarPubMed
Morris, J.N., Fries, B.E., Mehr, D.R., Hawes, C., Phillips, C., Mor, V., et al. (1994). MDS cognitive performance scale. Journal of Gerontology: Medical Sciences, 49, 174–182.CrossRefGoogle ScholarPubMed
Morris, J.N., Hawes, C., Fries, B.E., Phillips, C.D., Mor, V., Katz, S., et al. (1990). Designing the national resident assessment instrument for nursing homes. Gerontologist, 30, 293–302.CrossRefGoogle ScholarPubMed
Morris, J.N., Hawes, C., Murphy, K., & Nonemaker, S. (1995). Long-term care resident assessment instrument user's manual—Version 2.0. Baltimore, MD: Health Care Financing Administration.Google Scholar
Mulsant, B.H., & Ganguli, M. (1999). Epidemiology and diagnosis of depression in late-life. Journal of Clinical Psychiatry, 60(Suppl. 20), 9–15.Google ScholarPubMed
Phillips, C.D., Zimmerman, D., Bernabei, R., & Jonsson, P.V. (1997). Using the resident assessment instrument for quality enhancement in nursing homes. Age and Ageing, 26(Suppl. 2), 77–81.CrossRefGoogle ScholarPubMed
Rosen, J., Mulsant, B.H., & Pollock, B.G. (2000). Sertraline in the treatment of minor depression in nursing home residents: A pilot study. International Journal of Geriatric Psychiatry, 15, 177–180.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Rovner, B.W., German, P.S., Brant, I.J., Clark, R., Burton, L., & Folstein, M.F. (1991). Depression and mortality in nursing homes. Journal of the American Medical Association, 265, 993–996.CrossRefGoogle ScholarPubMed
Smyer, M.A., Shea, D.G., & Streit, A. (1994). The provision and use of mental health services in nursing homes: Results from the National Medical Expenditure Survey. American Journal of Public Health, 84(2), 284–287.CrossRefGoogle ScholarPubMed
Stones, M.J., & Kirkpatrick, W. (2002). Deconstructing depression: Dormancy and dysphoria. Stride, 14–19.Google Scholar
Teare, G., Daniel, I., Markel, F., McKillop, I., Pink, G., Rashkovan, N., & Weiler, L. (2004). Hospital report 2003: Complex continuing care (Joint initiative of the Ontario Hospital Association and the Government of Ontario). Toronto: Hospital Report Research Collaborative.Google Scholar
Teresi, J., Abrams, R., Holmes, D., Ramirez, M., & Eimicke, J. (2001). Prevalence of depression and depression recognition in nursing homes. Social Psychiatry and Psychiatric Epidemiology, 36(12), 613–620.CrossRefGoogle ScholarPubMed
U.S. Surgeon General (1999). Mental health: A report of the Surgeon General. Rockville, MD: U.S. Public Health Service.Google Scholar
Unutzer, J., Patrick, D.L., Simon, G., Grembowski, D., Walker, E., Rutter, C., et al. (1997). Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: A 4-year prospective study. Journal of the American Medical Association, 277, 1618–1623.CrossRefGoogle Scholar
Weintraub, D., Datto, C.J., Streim, J.E., & Katz, I.R. (2002). Second generation issues in the management of depression in nursing homes. Journal of the American Geriatrics Society, 50, 2100–2101.CrossRefGoogle ScholarPubMed